Department of Pediatrics, Salesi Children's Hospital, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Ancona, Italy.
Ital J Pediatr. 2009 Jul 20;35(1):21. doi: 10.1186/1824-7288-35-21.
Fractional exhaled nitric oxide (FeNO) is a useful tool to diagnose and monitor eosinophilic bronchial inflammation in asthmatic children and adults. In children younger than 2 years of age FeNO has been successfully measured both with the tidal breathing and with the single breath techniques. However, there are a number of methodological issues that need to be addressed in order to increase the reproducibility of the FeNO measurements within and between infants. Indeed, a standardized method to measure FeNO in the first 2 years of life would be extremely useful in order to meaningfully interpret FeNO values in this age group. Several factors related to the measurement conditions have been found to influence FeNO, such as expiratory flow, ambient NO and nasal contamination. Furthermore, the exposure to pre- and postnatal risk factors for respiratory morbidity has been shown to influence FeNO values. Therefore, these factors should always be assessed and their association with FeNO values in the specific study population should be evaluated and, eventually, controlled for.There is evidence consistently suggesting that FeNO is increased in infants with family history of atopy/atopic diseases and in infants with recurrent wheezing. These findings could support the hypothesis that eosinophilic bronchial inflammation is present at an early stage in those infants at increased risk of developing persistent respiratory symptoms and asthma. Furthermore, it has been shown that FeNO measurements could represent a useful tool to assess bronchial inflammation in other airways diseases, such as primary ciliary dyskinesia, bronchopulmonary dysplasia and cystic fibrosis. Further studies are needed in order to improve the reproducibility of the measurements, and large prospective studies are warranted in order to evaluate whether FeNO values measured in the first years of life can predict the future development of asthma or other respiratory diseases.
呼出气一氧化氮（FeNO）是一种有用的工具，可用于诊断和监测哮喘儿童和成人的嗜酸性支气管炎症。在 2 岁以下的儿童中，通过潮式呼吸和单次呼吸技术都成功地测量了 FeNO。然而，为了提高婴儿内和婴儿间 FeNO 测量的可重复性，还需要解决许多方法学问题。实际上，制定一种在生命前 2 年测量 FeNO 的标准化方法将非常有助于在该年龄段有意义地解释 FeNO 值。已经发现许多与测量条件有关的因素会影响 FeNO，例如呼气流量、环境 NO 和鼻腔污染。此外，暴露于呼吸发病率的产前和产后危险因素已被证明会影响 FeNO 值。因此，这些因素应始终进行评估，并应评估其与特定研究人群中 FeNO 值的相关性，并最终进行控制。有证据一致表明，家族史中有特应性/特应性疾病和反复喘息的婴儿的 FeNO 增加。这些发现可能支持这样一种假说，即在那些发生持续性呼吸道症状和哮喘风险增加的婴儿中，早期就存在嗜酸性支气管炎症。此外，已经表明 FeNO 测量可作为评估其他气道疾病（例如原发性纤毛运动障碍、支气管肺发育不良和囊性纤维化）中支气管炎症的有用工具。需要进一步的研究来提高测量的可重复性，并且需要进行大型前瞻性研究，以评估生命最初几年测量的 FeNO 值是否可以预测哮喘或其他呼吸道疾病的未来发展。
